AB1327 PREVALENCE OF IMMUNORELATED MUSCULOSKELETAL ADVERSE EFFECTS IN PATIENTS WITH LUNG CANCER OR MELANOMA TREATED WITH IMMUNO-CHECKPOINT INHIBITORS
Authors: L. Salvatierra Velasco, S. Sequero, J. Rubio Ubeda, D. Martinez Peñalver
Journal: Annals of the Rheumatic Diseases (2022)

Background mmunotherapy in the field of medical oncology, consisting of inhibiting key immune checkpoints, is revolutionising the way patients with these pathologies are treated, being mainly used in skin and lung tumours. These molecules are aimed at controlling T-cell activation by interacting with cytotoxic T-lymphocyte antigen 4 (CTLA-4) protein (Ipilimumab); by acting on the programmed cell death receptor (PD-1) (Pembrolizumad, Nivolumab); or by binding to programmed cell death ligand 1 (PDL-1) such as Atezolizumad or durvalumad. Despite the improvement in survival in the management of cancers with poor prognosis, this type of therapy is characterised by a series of side effects, including dermatological, gastrointestinal, endocrine, rheumatological and other effects. In this study, we focused mainly on rheumatological adverse effects, ranging from mechanical and/or inflammatory musculoskeletal involvement to dry syndrome, vasculitis, polymyalgia rheumatica, inflammatory myopathy, among others. Aims: To assess the prevalence of immuno-related adverse effects (Eair) in cancer patients with lung cancer or melanoma treated with immunotherapy targeting check-ponits, such as anti-CTLA-4, anti-PD-1, anti-PDL-1. Objectives To assess the prevalence of immuno-related adverse effects (Eair) in cancer patients with lung cancer or melanoma treated with immunotherapy targeting check-ponits, such as anti-CTLA-4, anti-PD-1, anti-PDL-1. Methods Observational study of a series of 115 patients diagnosed with lung cancer or melanoma, in treatment with checkpoint inhibitors (nivolumab, pembrolixumab, durvalumab, atezolizumab), from 2016 to 2021 at the Hospital Universitario Clínico San Cecilio. Patients who developed some type of rheumatological symptomatology after the start of immunotherapy were included. The clinical history of these patients was reviewed to confirm or rule out these adverse effects. The following musculoskeletal Eair were included: arthralgias, arthritis, generalised musculoskeletal pain, myalgias, osteoporosis and/or osteopenia. In the Eair registry, the following entities were not included: polymyalgia rheumatica, vasculitis and myositis. Results Out of a total of 115 patients who received immunotherapy, with age, type of tumour and treatment received (Table 1); 24 developed non-specific arthromyalgia, low back pain and/or neck pain, with no previous history of interest, and clearly related to the immunotherapy treatment. Five of the patients developed active arthritis with visible swelling; only one of them had previous RA with treatment, the others had no PA of interest. Of the patients with rheumatological involvement, x had underlying PsA, x had a family history of immune-mediated disease. Of the total patients, 2 had a gout flare-up (one of them with a previous diagnosis). Conclusion The most frequent rheumatological adverse effects related to immunotherapy are non-specific arthromyalgias considered to be grade 1 or 2 in severity, for which patients do not require specific treatment or suspension of treatment doses. However, several of the patients did develop active arthritis, requiring corticosteroid treatment and in some cases, the suspension of at least one treatment session. In our study, there is no clear relationship between one immunosuppressive drug or another for the development of Eair. Disclosure of Interests None declared